Diabetes during pregnancy affects the pregnant woman and her offspring. Toxemia and cesarean section are both more common in women with diabetes during pregnancy, and malformations, macrosomia, prematurity and perinatal mortality are more common in infants of diabetic mothers. Also, offspring of diabetic women are at an increased risk of developing obesity and glucose intolerance during childhood and young adulthood. The purposes of the project are to identify diabetes and impaired glucose tolerance during pregnancy in women in the Gila River Indian Community, to determine the effects of abnormal glucose tolerance on outcome of the pregnancy, and to determine long term prognosis for the women and their offspring. The diabetes status of every woman is determined at two-yearly intervals and during the third trimester of each pregnancy. The characteristics of women who have diabetes or impaired glucose tolerance during the pregnancy are compared to those of women who are normal during the pregnancy and subsequently develop diabetes and to those of women who remain normal. At birth, cord blood is collected for determination of glycosylated fetal hemoglobin and proinsulin, and maternal blood is also collected for glycosylated hemoglobin. These women and their offspring are followed at two-yearly intervals. It has been previously reported that offspring of diabetic women have more diabetes and more obesity than offspring of nondiabetic and prediabetic women. Diabetes mellitus during pregnancy in Pima Indian women results in offspring who have a higher prevalence of diabetes, 45% at age 20-24 years, than offspring of nondiabetic women, 1.4%, or offspring of prediabetic women, defined as women who developed diabetes only subsequent to the pregnancy, 8.6%. These differences persist after taking into account paternal diabetes, the age of onset of diabetes in the parents, and the offspring's relative weight for height. The findings suggest that the intrauterine environment is an important determinant of the development of diabetes, and that its effect is in addition to those of genetic factors.